Is PrEP the End of HIV in the U.S.?

(From the ADVOCATE)Over the past month, we've debunked more than two dozen myths about pre-exposure prophylaxis, or PrEP, explored what to expect on PrEP and how to get it covered by your employer's insurance, and offered tools for talking to your partner — and even your kids — about starting PrEP.

In fact, most doctors and activists — in addition to overarching agencies like the Centers for Disease Control and Prevention and the World Health Organization — urge that PrEP be used in conjunction with existing strategies (including condom use and regular testing) to minimize the risk of contracting HIV, especially for those who fall into one of several high-risk categories.

Experts say while it may not be the end-all, be-all in the ongoing fight against HIV, PrEP does provide an important new tool in that fight. Among a community that has for nearly 30 years preached the singular gospel of condom use, a change in tune — or more accurately, a harmony added to that ongoing chorus — could have a substantial impact.

"PrEP is a prevention game-changer because it allows us to offer more than one item on our HIV prevention menu," explains Daskalakis. "Now we can offer PrEP with the knowledge that it may provide the right type of protection for a person unable or unwilling to adhere to regular condom use."

Diane Havlir, a leading AIDS researcher, PrEP supporter, and professor at the University of California, San Francisco's School of Medicine, agrees with Daskalakis — then goes a step further to implicate PrEP in a broader paradigm-shift that has expanded the definition of "treatment as prevention" to apply beyond giving medication to HIV-positive people to reach undetectable viral loads so they can no longer transmit the virus, to giving medication to negative people that keeps them from ever acquiring HIV.

Survival of the individual is not the primary issue in disease control. In fact big plagues die out because too many of the hosts die taking the disease with it.

The Prep strategy is to prevent the propagation of HIV virus at the cost of the individual. The propaganda target is to the humanist gay man that is not very technical, wants to feel rather than think and draws his opinions from word of mouth rather than reading / research.

The second paragraph of the Truvada site warns of serious side effects of the drug. Truvada would have never been approved by the FDA without humanist pressure to do something, anything.

So as long as you aren't becoming infected, Prep is doing its job and if you die from complications of taking the drug that further reduces the likely hood of spreading the infection so it's a win /win for the fight against AIDS and $ for big Pharma.

First of all, I'd like to say that the lack of education on HIV on everybody, including gay community is just plain ridiculous.

HIV infects leukocytes through receptor-mediated endocytosis and binds to CD4 cells, which compose the membrane of helper T cells which are responsible for coordinated immune response. If antigens can't be presented to helper T cells, then the body can never signal B cells to create antibodies. To make matters worse, the loss of functional T cells causes suppressor T cells, leukocytes which are antagonistic to helper T and B cells, to accumulate to further wreak havoc on the lymphatic system.

Now, talking about PrEP. PrEP is just preventative measure! So far there hasn't been a person that has been completely cured of HIV, so pharmaceutical companies can't insert leukocytes that have the HIV antigen receptor on them. I think the main problem of HIV is not the actual virus, but the promotion of unprotected sex, especially in pornography and the nature of the gay community. So long as people are having unsafe sex, then the virus will keep evolving more efficient ways to invade the lymphatic system. People need to be educated and they need to stop being caught up in the moment and think about things like this!

It is really unclear. There are some models that suggest that it could (in the best of all possible worlds) be effective in stopping the disease. But there are a lot of unknowns. And in the internet age, the sort of misinformation that you see propagated above distorts everything. For an example, see the behaviors in Africa (and the US Republican Party) that are spreading Ebola today.

Prep is good preventative medicine from what the studies show but also prescribing it to my patients seems like I'm saying "okay, now go fuck raw". I don't want to encourage risky behavior but I do want to protect ppl if I can (including against themselves). I am also weary of people on medications for an illness they don't have and that can easily be prevented given all that we know about HIV.

1.) Side effects - Yes, there are side effects with the drug. That said, for most people they are minor and quite temporary. According to the studies, most participants on the drugs got over their side effects after the first week. We're talking basic things like headache, nausea, slightly reduced appetite, etc.

Because doctors know there are side effects to the drug, they recommend that Truvada users report any side effects. If the side effects are too crazy, they tell people to get off of Truvada. I fail to see what is wrong with this approach. You try something. If it fails, you stop using it. Most of the people in the study had little to no side effects.

2.) Drug resistance - Logically, it is only possible for HIV to develop a resistance to drugs when the person using the drugs is HIV positive. That's why you have to get an HIV test before you go on Truvada. Only those who are HIV negative can begin treatment. This makes sense because if you're positive, you really shouldn't be on Truvada. You should be using far more powerful antiretrovirals.

Doctors are already looking at the risk of drug resistance, and they are taking steps, like conducting regular HIV tests, to mitigate that. Is the system perfect? No. But what about people who are HIV positive and don't take their medications on time. Do we throw antiretrovirals under the bus because those people aren't perfect?

3.) It will lead to less condom use - None of the trials show this to be the case. Most people don't use condoms as regularly as they should anyway. The trials showed that people were actually more likely to use condoms because they were consulting with healthcare professionals on a regular basis. When someone is holding you accountable, it's harder to slip up.

Furthermore, a lot of people use condoms because they're more concerned about other STIs. You don't just stop having safe sex because your risk of contracting one of the STIs is less than your risk of contracting others. I say this as an educated person, but why couldn't we market the same message to the general public?

4.) The cost. If you have health insurance, there's a good chance your insurance provider will cover the cost of Truvada. Why? Because treating an actual HIV infection is far more costly than your Truvada prescription. If you don't have insurance, Obamacare will most likely cover your Truvada.

5.) But I'm healthy - I think the biggest barrier for most people is the ick factor of regularly taking a drug when they know themselves to be perfectly healthy. But we do this all the time. Which of you drinks coffee? Who has smoked a joint? How about a beer? Aspirin? Humans are regular drug users.

The irony is that the side effects of Truvada (if you are one out of the ten who do have side effects) pale in comparison to the "side effects" of alcohol consumption.Yet we drink all the time. Why is one of these okay while the other isn't?

I think we all need to wake up and stop letting our emotions get in the way of our decision making. The research is pretty clear that Truvada is a low-risk and highly effective means of preventing HIV infection - especially when you combine it with safe-sex practices like condom use. If people are responsible, it very well could spell the end of the HIV epidemic in the United States.

[quote][cite]theob said[/cite]I'm gonna take a contrarian stance and argue in favor of Truvada.

2.) Drug resistance - Logically, it is only possible for HIV to develop a resistance to drugs when the person using the drugs is HIV positive. That's why you have to get an HIV test before you go on Truvada. Only those who are HIV negative can begin treatment. This makes sense because if you're positive, you really shouldn't be on Truvada. You should be using far more powerful antiretrovirals.

The trials excluded persons who became HIV POZ or were not taking their medications consistently. In doing so a perfect world scenario was measured not real world conditions. So when those who don't adhere to treatment take the medication on the in between period there is the opportunity to develop what could later become drug resistance

Doctors are already looking at the risk of drug resistance, and they are taking steps, like conducting regular HIV tests, to mitigate that. Is the system perfect? No. But what about people who are HIV positive and don't take their medications on time. Do we throw antiretrovirals under the bus because those people aren't perfect?

3.) It will lead to less condom use - None of the trials show this to be the case. Most people don't use condoms as regularly as they should anyway. The trials showed that people were actually more likely to use condoms because they were consulting with healthcare professionals on a regular basis. When someone is holding you accountable, it's harder to slip up.

Furthermore, a lot of people use condoms because they're more concerned about other STIs. You don't just stop having safe sex because your risk of contracting one of the STIs is less than your risk of contracting others. I say this as an educated person, but why couldn't we market the same message to the general public?

You are 'kidding me' I hope in your inferences as I can tell you from meeting a young man who stated he doesn't like condoms after pressure from me he relented only to attempt to sneakily remove it. We stopped sex then and later on I drove him to his appointment for counselling. He freely admitted he didn't adhere to the treatment as he should do to me and that he has felt free to BB often because he believes the fear of HIV is no longer an issue. I had been talking to this young man for 3 months prior to meeting him and there is no problem with more meeting or encounters however a per several others I have spoke to Prep is seen as the party green light

Sydneyrugbyjock73 said[quote][cite]theob said[/cite]I'm gonna take a contrarian stance and argue in favor of Truvada.

2.) Drug resistance - Logically, it is only possible for HIV to develop a resistance to drugs when the person using the drugs is HIV positive. That's why you have to get an HIV test before you go on Truvada. Only those who are HIV negative can begin treatment. This makes sense because if you're positive, you really shouldn't be on Truvada. You should be using far more powerful antiretrovirals.

The trials excluded persons who became HIV POZ or were not taking their medications consistently. In doing so a perfect world scenario was measured not real world conditions. So when those who don't adhere to treatment take the medication on the in between period there is the opportunity to develop what could later become drug resistance

Doctors are already looking at the risk of drug resistance, and they are taking steps, like conducting regular HIV tests, to mitigate that. Is the system perfect? No. But what about people who are HIV positive and don't take their medications on time. Do we throw antiretrovirals under the bus because those people aren't perfect?

3.) It will lead to less condom use - None of the trials show this to be the case. Most people don't use condoms as regularly as they should anyway. The trials showed that people were actually more likely to use condoms because they were consulting with healthcare professionals on a regular basis. When someone is holding you accountable, it's harder to slip up.

Furthermore, a lot of people use condoms because they're more concerned about other STIs. You don't just stop having safe sex because your risk of contracting one of the STIs is less than your risk of contracting others. I say this as an educated person, but why couldn't we market the same message to the general public?

You are 'kidding me' I hope in your inferences as I can tell you from meeting a young man who stated he doesn't like condoms after pressure from me he relented only to attempt to sneakily remove it. We stopped sex then and later on I drove him to his appointment for counselling. He freely admitted he didn't adhere to the treatment as he should do to me and that he has felt free to BB often because he believes the fear of HIV is no longer an issue. I had been talking to this young man for 3 months prior to meeting him and there is no problem with more meeting or encounters however a per several others I have spoke to Prep is seen as the party green light

"Logically, it is only possible for HIV to develop a resistance to drugs when the person using the drugs is HIV positive."

Not true at all. You can become drug resistant when Neg and on PrEP.

Let me guess, you were blaming HIV/Undetectable for drug resistance for all people??